Asthma management, Part II: Pharmacologic management.

Advances in pediatric asthma in 2009: Gaining control of childhood asthma

Current research and future needs in allergic rhinitis and asthma

PurposeTo present a comprehensive flood management plan for Malaysia, the various planning stages and the proponents of the plan. It is also to expound and highlight the importance of spatial information technology in the strategy and to outline the critical decision‐making at various levels of the plan.Design/methodology/approachA review of flood disaster management aimed at providing an insight into the strategies for a comprehensive flood disaster management for Malaysia. Discussion of the framework of a spatial decision support system (SDSS) and its role in decision‐making in a comprehensive disaster management plan.FindingsProvides information about a proposed comprehensive disaster management program for Malaysia and highlight the role of SDSS in improving decision‐making. It recognizes the strength of SDSS in the collection and processing of information to speed up communication between the proponents of the disaster management program. A well‐design SDSS for flood disaster management should present a balance among capabilities of dialog, data and modeling.Research limitations/implicationsThe study has outlined the links and components of SDSS and not its development processes; this may limit the used of this paper in in‐depth study of the development if SDSS. Some source for detail study of the development of SDSS have, however, been cited.Practical implicationsThis paper is a very useful source of information about the preparation of a comprehensive disaster management program. It also sheds light on the role of SDSS in improving and speeding up communication between the various proponents of the program. Researcher and students will fine, it provides general guidelines and framework for disaster planning and management.Originality/valueThis paper fulfills flood disaster study need for developing a comprehensive disaster management program. It presents the framework of SDSS, the interrelationship between their various components and how they play a role in decision‐making.

BackgroundImproved maternal asthma management in pregnancy may reduce recurrent bronchiolitis and wheeze outcomes in infancy. We assessed whether infant bronchiolitis and wheeze outcomes are influenced by inflammation-guided management intervention, inhaled corticosteroid (ICS) use or exacerbations in pregnancy.MethodsA randomised controlled trial (RCT) secondary analysis and observational cohort analysis using the same study population was carried out. Pregnant women (12–23 weeks’ gestation) from six centres in Australia were recruited and randomised to inflammation-guided asthma management or usual care between 2013 and 2023. ICS use and asthma exacerbations were reported during pregnancy and postnatally. When infants were 6 (n=691) and 12 (n=606) months of age, respiratory information was collected from parents and medical records. Associations for the RCT and observational analyses were assessed with logistic regression.ResultsGuided asthma management in pregnancy was not associated with bronchiolitis or wheeze-related outcomes, for example for recurrent bronchiolitis at 12 months, the intervention OR was 1.04 (95% CI 0.62–1.73). In the observational analyses, ICS use in pregnancy was not associated with respiratory outcomes; however, asthma exacerbations in pregnancy were associated with at least one bronchiolitis episode (adjusted odds ratio (adjOR) 2.20, 95% CI 1.28–3.76) or croup episode (adjOR 4.34, 95% CI 1.89–9.96) at 6 months, and wheeze (adjOR 1.80, 95% CI 1.14–2.84) and increasing wheeze episodes at 12 months (adjOR 1.81, 95% CI 1.17–2.79).ConclusionAlthough there was no evidence that guided asthma management or ICS use in pregnancy reduces infant bronchiolitis or wheeze, maternal asthma exacerbations are an important risk factor for these outcomes. Further research is needed to reduce exacerbations in pregnancy.

The first step in comprehensively evaluating implementation of an integrated estuarine management plan: Developing evaluation criteria

BackgroundCountries of the Mediterranean basin such as Cyprus are experiencing frequent desert dust storm (DDS) events that adversely impact children with asthma. As school health visitors (SHVs) have important role in asthma management, we examined SHVs practices and perceptions on asthma management and their level of engagement in school-based interventions to mitigate DDS- health effects.MethodsA descriptive cross-sectional survey was conducted among SHVs across state schools in Cyprus via an anonymous questionnaire, which rated the importance of asthma management measures (10-point scale), current implementation of these practices (1=never - 5=always), and regulatory authorities’ preparedness to respond to DDS events (1-5 Likert scale).ResultsResponses from 78 of the 93 SHVs (84%), with an average work experience of 13.5 years (SD 7.3), revealed discordance between high perception of the importance of asthma management measures and their actual implementation, with poor scoring especially in assessment of asthma control (M = 2.4, SD = 1.5), tracking school absenteeism (M = 2.1, SD = 1.0) and monitoring of asthma triggers (M = 1.9, SD = 1.4). Any DDS-related measures (e.g. air quality real-time monitoring, warnings, recommendations, awareness campaigns, etc) were implemented very infrequently. Ratings of authorities’ preparedness were moderate (<3.5), and only slightly higher in the health versus the educational or other government services. SHVs who recognized the severity of DDS and potential impact on asthmatic children were more likely to support school-based interventions for DDS events (OR = 7.3, 95% CI: 2.1-25.3).ConclusionsAsthma management practices in school settings in Cyprus are suboptimal and responses during DDS are fragmented. While SHV’s awareness and support for interventions is high, this is not reflected in current practices. A concerted effort is needed for adoption of policies and implementation of action plans for DDS within school settings.Key messages• Suboptimal asthma management policies and practices were found to be implemented in schools in Cyprus, a country highly exposed to dust events.• School health visitors recognize the health impact of desert dust on asthmatic children and support the plan for dust-mitigation programmes in schools, despite authorities’ low preparedness.

Asthma Management During Pregnancy

Monoclonal antibodies (mAbs) play a crucial role in the treatment of severe asthma. Physicians rely on patient-specific characteristics to determine the appropriate asthma classification for treatment. Currently, there are five biological agents designed to target the 'TH2-high' asthma phenotype, characterized by inflammation primarily driven by type 2 T-helper cells (TH2). This subtype is associated with severe eosinophilic asthma, marked by elevated levels of immunoglobulin E, fractional exhaled nitric oxide (FeNO), and eosinophils. In contrast, the ' TH2-low' asthma phenotype, characterized by increased sputum neutrophil counts and activation of the TH17-mediated interleukin-17 pathway, remains less understood. This review examines the role of mAbs in the management of severe asthma, with a focus on their efficacy in different asthma phenotypes. We analyze existing literature, clinical trials, and studies involving mAbs in severe asthma treatment, particularly those targeting thymic stromal lymphopoietin (TSLP). Biologics targeting 'TH2-high' asthma have shown promising outcomes, effectively reducing symptoms and exacerbations. However, the management of ' TH2-low' asthma remains a challenge due to limited therapeutic options. Recent medical trials have explored the use of mAbs, specifically TSLP-targeting mAbs, which have demonstrated significant efficacy in improving asthma control, even in ' TH2-low' phenotypes. Monoclonal antibodies have revolutionized the treatment of severe asthma, primarily focusing on the ' TH2-high' phenotype. While challenges persist in addressing ' TH2-low' asthma, recent developments, particularly TSLP-targeting mAbs, provide hope for more comprehensive asthma management across various phenotypes. Further research is needed to expand our understanding of ' TH2-low' asthma and explore additional biological agents that may be effective in its treatment. Clinicians should consider personalized treatment approaches, including mAbs, based on the specific asthma phenotype of each patient to optimize asthma management.

Expert Panel Report 3: Moving forward to improve asthma care

Comprehensive nutrient management plans are being promoted to reduce excess nutrient applications on livestock farms to improve water quality. Development of these plans has been shown to exhibit increasing returns to scale but these costs did not include farmer time. Data from a farmer survey are used to characterize the magnitude and determinants of the transaction costs of comprehensive nutrient management plan development in the Midwest. The analyses confirm that the time spent by farmers exhibits increasing returns to scale. Ignoring the hours spent by farmers on plan development underestimates time requirements by approximately 10%.

Exhaled nitric oxide to predict corticosteroid responsiveness and reduce asthma exacerbation rates

Patients with severe persistent asthma who are inadequately controlled despite treatment according to current asthma management guidelines have a significant unmet medical need. Such patients are at high risk of serious exacerbations and asthma-related mortality. Here, we pooled data from seven studies to determine the effect of omalizumab, an anti-immunoglobulin E (IgE) monoclonal antibody, on asthma exacerbations in patients with severe persistent asthma. Omalizumab was added to current asthma therapy and compared with placebo (in five double-blind studies) or with current asthma therapy alone (in two open-label studies). The studies included 4308 patients (2511 treated with omalizumab), 93% of whom had severe persistent asthma according to the Global Initiative for Asthma (GINA) 2002 classification. Using the Poisson regression model, results were calculated as the ratio of treatment effect (omalizumab : control) on the standardized exacerbation rate per year. Omalizumab significantly reduced the rate of asthma exacerbations by 38% (P < 0.0001 vs control) and the rate of total emergency visits by 47% (P < 0.0001 vs control). Analysis of demographic subgroups showed that the efficacy of omalizumab on asthma exacerbations was unaffected by patient age, gender, baseline serum IgE (split by median) or by 2- or 4-weekly dosing schedule, although benefit in absolute terms appeared to be greatest in patients with more severe asthma, defined by a lower value of percentage predicted forced expiratory volume in 1 s (FEV(1)) at baseline. These results suggest that omalizumab may fulfil an important need in patients with severe persistent asthma, many of whom are not adequately controlled on current therapy.

A comprehensive water quality management plan was prepared for the Laguna de Bay Basin located near Metropolitan Manila, Philippines. The need for this management plan has been created by the confrontation between resources development and environmental conservation and made complex by the spill‐over of Metro‐Manila population, industrial and commercial growths and agricultural development in the watershed of this large inland tropical lake. A water quality management plan was prepared by Government with the cooperation of international agencies to protect the natural resources so that the beneficial uses of the lake can be preserved. The initial phases of the comprehensive water quality management plan are under implementation.

Objective: To investigate the effectiveness of technology enabled learning in improving asthma first aid knowledge and self-confidence in providing asthma first aid to children in staff within a school setting. Study Design: A prospective randomized parallel study using a pre and post test design was conducted across Metropolitan schools of New South Wales (NSW), Australia. School staff in selected schools were randomly assigned to receive first aid asthma management training via a self-directed multimedia eBook learning resource or standard face-to-face training. Staff completed a 14 item validated Asthma First Aid Knowledge Questionnaire and a 4 item, 10-point Likert-scale asthma management self-confidence questionnaire immediately pre and post training. Results: 148 school staff from 46 schools were recruited with a total of 59 (78%) staff completing the eBook training and 62 (86%) completing face-to-face training. The mean asthma first aid knowledge score and self-confidence score in managing asthma increased significantly (p < 0.0001) in the eBook training group post training. There was no significant difference in the increase in the mean scores post training between the eBook and face-to-face training groups (p = 0.11). Conclusion: Asthma management knowledge and self-confidence increased in school staff following the eBook training. In school settings where human resources for health education are limited, technology enabled learning may be substituted to provide a self-directed approach to asthma first aid management training.

Clinical course of asthma in 4 cases of coronavirus disease 2019 infection